LP/NATURAL GAS LICENSE (0601, 0803, & 0408) APPLICATION
GENERAL INFORMATION
READ INSTRUCTION SHEET BEFORE COMPLETING THIS FORM
ALL INFORMATION MUST BE TYPED OR CLEARLY PRINTED
ILLEGIBLE APPLICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED
APPLICATION FEES ARE NON-REFUNDABLE
1.
Who must file for a “Liquefied Petroleum” license?
Any resident or nonresident who intends to operate and qualify a business firm/
corporation, or contract or sub-contract any L.P. Gas related installation, piping,
equipment/appliance connection and related accessories, into any permanent structure
within Hillsborough County or the municipalities therein. Changes in Florida Statutes,
Chapter 527 now allow L.P. license holders to install natural gas.
2.
What are the Contractor’s responsibilities?
It shall be the duty of every contractor who shall make contracts for the installation of
L.P. Gas, for which a permit is required, to comply with the rules and regulations
concerning licensing required by both the State and the Local jurisdiction in which the
work is being performed.
3.
What if there is a change in status?
If the qualifier is no longer an active partner or officer of the firm/corporation, both the
firm/corporation and the individual qualifying the firm/corporation must notify the
Hillsborough County Contractor Licensing Team, Development Services Division within
48 hours of this change in status.
Each business location shall have a “qualifier” (as defined in Florida Statutes, Chapter
527) separately licensed. Every business organization shall possess a full-time qualifier
at all times. A qualifier must actually function in a supervisory capacity and be
responsible for other company employees installing L.P. Gas related systems.
4.
How do I get a “Temporary” license?
The Gas Board of Adjustments, Appeals and Examiners shall determine whether an
applicant is qualified to receive a L.P. Gas license. A temporary license may be issued
until the next scheduled Board Meeting. The applicant must appear, in person, at the
scheduled Board Hearing to answer any questions regarding qualifications relating to
his/her experience, credit history, and/or background.
5.
How are licenses and certificates renewed?
All licenses expire annually, State licenses on August 31 and Local licenses become
invalid if not renewed on or before September 30. Hillsborough County accesses
delinquent fees if the Local license is not renewed prior to October 1 of each year. If a
Certificate is not renewed for 2 consecutive years, the license holder will have to
reapply as a new applicant and appear before the Gas Board.
L.P./NATURAL GAS APPLICATION CHECK LIST
o Application complete (all blanks filled out) and recent photograph (passport style head shot)
attached. The Hillsborough County Gas Board of Adjustment, Appeals and Examiners will not
review an application unless it is filled out completely on forms provided by the Hillsborough
County Contractor Licensing Team, and all required information must be attached. All information
must be typed or clearly printed as illegible or incomplete applications will not be accepted and will
not be taken before the Board.
o Verification of Work Experience form completed and signed by a licensed Gas contractor.
Description of work experience must be specific at to dates and type of work performed.
Hillsborough County’s minimum requirements are 6 years of experience, 2 years of which must
have been in a Supervisory or Master’s position.
o Photocopy of State LP gas license indicating license type and location of business (0601, 0803, or
0408)
o Photocopy of “Certificate of Examination”, qualifier card, issued by the State of Florida Bureau of
LP Gas Inspections, included. Card must show test scores on card.
o Photocopy of current Drivers License.
o Any documentation of training (copies of certificates received as a result of training, classes
attended, etc.
o 3 letters of recommendation from responsible persons who know you and your work, one of whom
must be an Industry member or Gas contractor.
o Copy of Workers’ Compensation, or exemption thereof. Certificate Holder must indicate
Hillsborough County Contractor Licensing.
o Original Hillsborough County Contractor’s Code Compliance Bond.
o $75 Application Fee (cash, check or credit card).
NOTE: By submittal of an application, the applicant authorizes Hillsborough County to pull a
Credit Report and Background Check which then becomes a part of the application.
All applications should be delivered to:
Hillsborough County Development Services Division
CONTRACTOR LICENSING TEAM
5701 E. Hillsborough Avenue, Suite 2459
Tampa, Florida 33610
Phone (813) 635-7308/09
Fax: (813) 635-7367
(The above office is located in the southeast corner of Hillsborough
Avenue and 56th Street, in the Net Park Office Facility formerly
known as East Lake Square mall)
LP/NATURAL GAS LICENSE APPLICATION (0601, 0803, & 0408)
READ INSTRUCTION SHEET BEFORE COMPLETING THIS FORM
ALL INFORMATION MUST BE TYPED OR CLEARLY PRINTED
ILLEGIBLE APPLICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED
APPLICATION FEES ARE NON-REFUNDABLE
NOTE: All requirements and criteria from the State Bureau of
L.P. Gas must be met before applying for local licensure.
TYPE OF LICENSE APPLIED FOR
ATTACH
RECENT
PHOTO
HERE
_____ 0601 CATEGORY I, L.P. GAS DEALER
_____ 0803 INSTALLER “A”
_____ 0408 INSTALLER “B”
TYPE OF STATE LICENSE ISSUED
_____________________________________
Date Issued____________________________
PERSONAL DATA
Name: _________________________________________ _ Date: ___________________
Date of Birth: ______________________ Social Security No: _________________________
Res. Address: _______________________________________________________________
City: ____________________________ __ Zip Code: ___________ Ph: _______________
Bus. Address: _______________________________________________________________
City: ______________________________ Zip Code: ___________ Ph: _______________
Military Service (Branch) __________________ Service No: __________________________
American Citizen? ____________ Present Job Title: ________________________________
NOTE: If you are not an American Citizen, provide documentation with application indicating
you are legally working in the United States.
EDUCATION
High School: (Name, City, State)
Years Attended
Graduate Degree
_________________________________________ _____________
________ ______
College or University: (Name, City, State)
Years Attended
Graduate Degree
_________________________________________ _____________
________ ______
_________________________________________ _____________
________ ______
Trade School: (Name, City, State)
Years Attended
Graduate Degree
_________________________________________ _____________
________ ______
_________________________________________ _____________
________ ______
I HEREBY CERTIFY THAT ALL INFORMATION
SUBMITTED IS TRUE AND CORRECT
STATE OF ______________________________________
COUNTY OF ____________________________________
__________________________________________
Signature of Applicant
Subscribed and sworn to before me this ________________
Affix Notary Seal
day of ______________________________, 20__________
Personally Known _______ OR Produced Identification
_________________________________________________
(Type of Identification Produced)
_________________________________________________
Notary Public (Signature)
My Commission expires:_____________________________
VERIFICATION OF CONSTRUCTION EXPERIENCE
ALL INFORMATION IS TO BE TYPED OR PRINTED
ILLEGIBLE APPLICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED
Hillsborough County Development Services Division
CONTRACTOR LICENSING TEAM
5701 E. Hillsborough Avenue, Suite 2459
Tampa, Florida 33610
_______________________________, 20_____
Date
___________________________________________ is/was employed by ________________________________________
(Applicant’s Name)
(Circle one)
(Company Name)
located at ___________________________________________________________________________ full/part time*
(Complete Company Mailing Address)
(circle one)
from
___________________________________, ____________ to ___________________________________, ____________.
(Start Date)
(Year)
(End Date)
(Year)
*Full time employment is considered having worked a minimum of 2,000 hours/year.
Describe, in your own words, what you know of the applicant’s experience. Describe the type of work he/she
performed and whether his/her position was as an apprentice, helper, journeyman, foreman, supervisor, or
contractor. Describe the kind of buildings, structures, or projects worked upon. Give any details that might aid in
evaluating his/her experience. Attach additional page(s) as necessary.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I am the qualifier for the above firm and hold current Contractor License No.______________________
from________________________________________________ as a____________________________________ contractor.
(Jurisdiction Where License was Issued)
(Type of License Held)
STATE OF ___________________________________________
COUNTY OF _________________________________________
Sworn to (or affirmed) and subscribed before me this
___________________________________________
Signature of License Holder
__________, day of ___________________________, 20_______
by ___________________________________________________
(Printed/Typed Name of License Holder Making Statement)
NOTARY PUBLIC
_____________________________________________________
___________________________________________
Printed Name of License Holder
(Signature of Notary)
_____________________________________________________
(Name of Notary Typed, Printed, or Stamped)
My Commission expires:_________________________________
Personally Known _______ OR Produced Identification
Affix
Seal
_____________________________________________________
(Type of Identification Produced)
NOTE: If applicant is self-employed, notarized letters from Building Officials, licensing agencies, and/or contractors
you performed work for will be accepted. This form may be duplicated. Verification forms must be furnished to
substantiate the minimum experience in the category for which application is made.
VERIFICATION OF CONSTRUCTION EXPERIENCE
ALL INFORMATION IS TO BE TYPED OR PRINTED
ILLEGIBLE APPLICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED
Hillsborough County Development Services Division
CONTRACTOR LICENSING TEAM
5701 E. Hillsborough Avenue, Suite 2459
Tampa, Florida 33610
_______________________________, 20_____
Date
___________________________________________ is/was employed by ________________________________________
(Applicant’s Name)
(Circle one)
(Company Name)
located at ___________________________________________________________________________ full/part time*
(Complete Company Mailing Address)
(circle one)
from
___________________________________, ____________ to ___________________________________, ____________.
(Start Date)
(Year)
(End Date)
(Year)
*Full time employment is considered having worked a minimum of 2,000 hours/year.
Describe, in your own words, what you know of the applicant’s experience. Describe the type of work he/she
performed and whether his/her position was as an apprentice, helper, journeyman, foreman, supervisor, or
contractor. Describe the kind of buildings, structures, or projects worked upon. Give any details that might aid in
evaluating his/her experience. Attach additional page(s) as necessary.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I am the qualifier for the above firm and hold current Contractor License No.______________________
from________________________________________________ as a____________________________________ contractor.
(Jurisdiction Where License was Issued)
(Type of License Held)
STATE OF ___________________________________________
COUNTY OF _________________________________________
Sworn to (or affirmed) and subscribed before me this
___________________________________________
Signature of License Holder
__________, day of ___________________________, 20_______
by ___________________________________________________
(Printed/Typed Name of License Holder Making Statement)
NOTARY PUBLIC
_____________________________________________________
___________________________________________
Printed Name of License Holder
(Signature of Notary)
_____________________________________________________
(Name of Notary Typed, Printed, or Stamped)
My Commission expires:_________________________________
Personally Known _______ OR Produced Identification
Affix
Seal
_____________________________________________________
(Type of Identification Produced)
NOTE: If applicant is self-employed, notarized letters from Building Officials, licensing agencies, and/or contractors
you performed work for will be accepted. This form may be duplicated. Verification forms must be furnished to
substantiate the minimum experience in the category for which application is made.
CONTRACTOR’S CODE COMPLIANCE BOND
(INSTRUCTIONS AND BLANK BOND)
Attached is the bond form required of all contractors working in Hillsborough County. The bond must
be correct in order to be accepted. Please insure your bonding company completes all lines.
1. Upper Left: “Bond For” must state what classification of contractor the bond covers (i.e. Building,
General, Mechanical, Electrical, Plumbing, Gas, Specialty (specific trade), Swimming Pools,
Roofing, Irrigation, etc.). NOTE: A separate bond is required for each license category/license
held.
2. The first blank space in Paragraph 1 must contain the complete name of the “Principal” (License
Holder) or the license holder’s name and company name if the contractor is qualifying a corporation
or firm. If the contractor holds a state license, the name on this bond must read the same as the state
license. BONDS WITH ONLY COMPANY NAMES WILL NOT BE ACCEPTED.
EXAMPLE
John Doe/Individual
Or
John Doe/Smith & Miller, Inc.
If the certified person qualifies on behalf of a corporation or firm, the person must be an active
officer of that corporation or firm, or must be its designated agent.
3.
4.
5.
6.
Only one (1) corporation or firm name is permitted.
The second blank space in Paragraph 1 names the Insurance Company providing the bonding.
The first blank space in Paragraph 2 must contain the name as indicated in Item 2 above.
The “Principal” (license holder) must sign the bond and indicate his “Title” when qualifying as a
corporation or firm.
7. All bonds shall be “Continuous” until cancelled. The Hillsborough County Licensing Section
must receive all Notices of Cancellation no later than 15 days prior to the effective date of bond
cancellation.
8. The Bonding Company is to notify, in writing, the Hillsborough County Building Code Compliance
Team at (813) 635-7300 when any claim is made on any bond, whether paid on or not.
9. All bonds must contain the seal of the insurance company and be signed by the Attorney-in-Fact for
the insurance company. The Insurance Company must attach a Power-of- Attorney to all bonds.
Please direct all correspondence/communication to:
Hillsborough County Development Services Division
CONTRACTOR LICENSING TEAM
5701 E. Hillsborough Avenue, Suite 2459
Tampa, Florida 33610
Phone (813) 635-7308/09
04/21/03
Fax: (813) 635-7367
CONTRACTOR’S CODE COMPLIANCE BOND
ALL INFORMATION IS TO BE TYPED OR PRINTED
BOND FOR _________________CONTRACTOR
(Type of License Held)
BOND NUMBER___________________
INSURANCE AGENT _______________________ PHONE NUMBER (_____)___________
KNOW ALL MEN BY THESE PRESENTS
That we,_________________________________________________________________________and
(License Holder’s Name if Individual or Name and Company Name if qualifying a Company)
__________________________________________________________________________________,
(Name of Insurance Company Providing Bond)
a corporate authorized to do business in the State of Florida (hereafter called Surety), are held and firmly
bound unto ____________________________, Governor of the State of Florida, and his successors in
office, in the penal sum of Five Thousand Dollars ($5,000), the true payment whereof well and truly to
be made we do bind ourselves, our respective heirs, executors, administrators, successors, and assigns,
jointly and severally, firmly by this bond.
DATED THIS___________________ DAY OF__________________________________, 20_______
The condition of this bond is such that if the above bound Principal, the said
_____________________________________________________ shall protect all persons suffering any
loss or damage occasioned by said Principal failing to comply with any of the provisions of any
municipal or county code applicable to the work performed by said Principal or officer, employee or
agent of said Principal, or under the direction and supervision of said Principal and shall, without
additional cost to the person for whom any such work is performed,, remedy all defects in said work due
to faulty workmanship or material furnished or used by said Principal, and shall reconstruct any such
defective work and will replace or make good any such defective material to the satisfaction of the
inspector having jurisdiction of the class of work embraced in the Code applicable thereto, at any time
within one (1) year after the performance of any such work by said Principal, his agents or employees,
and within forty-eight (48) hours after notice from such inspector to reconstruct, replace or repair the
same, then this obligation shall become null and void; otherwise to remain in full force and effect.
The failure or default on the part of the Principle in remedying any defects in such work due to faulty
workmanship or incorrect construction or installation or due to faulty materials furnished or used by said
Principal, shall give the person for whom such work is performed a right of action against the Principal
and Surety under this obligation; provided, however, that no suit, action, or proceeding by reason of any
default shall be brought on this bond after one (1) year from date of final completion of the work done
by the Principal for any such person.
This bond shall be considered continuous until such time as notification of cancellation is furnished to
the Hillsborough County Development Services Division, Construction Licensing Team. Cancellation
must be received no less than 15 days prior to the cancellation effective date.
______________________________________
Surety____________________________________
Printed/Typed Principal License Holder’s Name
______________________________________
By_______________________________________
Principal License Holder’s Signature
Attorney-in-Fact or Surety
(Affix Insurance Company Seal)
10/06/03
AUTHORIZATION FOR PAYMENT BY CREDIT CARD
Planning and Growth Management Department, Development Services Division
OFFICE USE ONLY
Permit No.
License No.
Total $
Fee $
PERMITS
Complete the following:
Job Site Address _________________________________________________________
City _________________________________, Florida Zip Code _________________
Type of Payment:
_____ VISA
_____ MasterCard
_____ Discover
Card Number: ______________________________________ Expiration Date _______________
V Code:
_______________ (Last three digits on the back of the card)
Name (print or type) _____________________________________________________________
(Name as it appears on the Credit Card)
Card Billing Address _____________________________________________________________
(Address used by Credit Card Company to mail billing statements)
City _____________________________________, State_____________ Zip Code ___________
Cardholder Signature _____________________________________________________________
All information, including zip code, must be completed or your request will not be processed. A
completed form and signature authorizes Hillsborough County staff to charge fees and/or payments for
services or permits as applicable to the cardholder’s credit card.
FOR YOUR CREDIT CARD SECURITY
FAX YOUR CREDIT CARD INFORMATION TO THE FOLLOWING
NUMBERS ONLY
______________________________________________________________________________________________________________________________
PERMITTING FAX NUMBERS
Area Code 813
County Center (Downtown) 276-2671
Netpark
635-7365
Northwest Office 264-8551
Plant City 757-3804
South County
672-7424
____________________________________________________________________________________
CONTRACTOR LICENSING FAX NUMBER
License No. ___________________________________
(If licensed, include license number)
(813) 635-7367 (this number is only for faxing forms to Contractor Licensing)
10/06/03
PERMIT AGENT AUTHORIZATION LETTER
ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED
I, ______________________________________________, __________________________,
(Contractor Name)
(Contractor License No.)
hereby authorize the following to act as my agent(s) in obtaining permits in Hillsborough
County, Florida.
Name of Agent
Driver’s License No.
--
--
--
--
--
--
--
--
--
--
--This letter supercedes any previously submitted letter(s) of authorization.
This letter must contain only the people you want to pull permits in your name. To make
changes to this letter, you must submit a new letter. This letter will delete and replace any
previous authorization letter and the information contained thereon.
This authorization is to remain in effect, unless cancelled in writing, by the undersigned.
STATE OF ___________________________________________
_____________________________________
Contractor’s Signature
COUNTY OF _________________________________________
Sworn to (or affirmed) and subscribed before me this
__________, day of ___________________________, 20_______
Affix
Notary
Seal
by ___________________________________________________
(Printed/Typed Name of License Holder Making Statement)
NOTARY PUBLIC
_____________________________________________________
(Signature of Notary)
_____________________________________________________
(Name of Notary Typed, Printed, or Stamped)
My Commission expires:_________________________________
Personally Known _______ OR Produced Identification
_____________________________________________________
(Type of Identification Produced)
10/06/03